Quality Standards for Diabetes Care Toolkit

Diabetes UK recommends that hospitals should:

have a ‘clinical lead’ for the management of the adult patient admitted with uncontrolled diabetes, diabetic ketoacidosis or hyperosmolar hyperglycaemic nonketotic syndrome with responsibility for implementation of the hospital guidelines

collect data about the outcomes for patients admitted with diabetic ketoacidosis or hyperosmolar hyperglycaemic nonketotic syndrome

have the services of a dedicated Diabetes Inpatient Specialist Nurse (DISN) at staffing levels most recently recommended by Diabetes UK (1.0 full-time equivalent [FTE] per 300 beds) (NICE 2011b)

have a Quality Assurance Scheme in place to ensure accuracy of blood glucose and ketone meters

have a training programme in place for all health care staff expected to prescribe, prepare and administer insulin (eg, the safe use of insulin and the safe use of intravenous insulin e-learning packages from National Health Service [NHS] Improving Quality)

ensure they commission a service providing access to a specialist diabetes team prior to a patient’s discharge with follow-up after discharge for all patients admitted to hospital with diabetic ketoacidosis, uncontrolled diabetes or hyperosmolar hyperglycaemic nonketotic syndrome (NICE 2011c).
Education should include:

self-managing diabetes in order to prevent DKA or HHNS through effective self-monitoring and regular insulin doses according to need to prevent recurrence (Mills et al 2014)

discussion of sick day advice

assessment of the need for home ketone testing (blood or urinary) with education to enable this

provision of contact telephone numbers for the diabetes specialist team and their primary health care providers.
People admitted to hospital with uncontrolled diabetes should be discharged with a written care plan: a process that allows the person with diabetes to have active involvement in deciding, agreeing and owning how their diabetes is managed (see Standard 3). This should be copied to the primary health care team who will be involved in ongoing follow-up. Further access to structured education (see Standard 1) offered within three months of discharge may decrease readmission rates further (Joint British Diabetes Societies for Inpatient Care Group 2013).
Regarding discharge planning:

discharge planning should start at hospital admission and clear diabetes management instructions should be provided at discharge

discharge summaries should be transmitted to the primary health care professional as soon as possible after emergency department attendance or discharge

information on medication changes, pending tests and studies and follow-up needs should be communicated clearly to the primary health professional, particularly those with uncontrolled diabetes

using a template for discharge summaries is helpful to ensure inclusion of relevant information.